President Barack Obama is expected to issue an executive order as soon as this week that would freeze deportations for up to 5 million immigrants living in the country illegally, but they're likely to remain ineligible for Medicaid coverage and exchange subsidies.
In 2012, the Obama administration established the Deferred Action for Childhood Arrivals program. It allows law-abiding immigrants who came to the country as children to avoid deportation. More than 500,000 undocumented immigrants have been approved for the program.
But shortly after the DACA program was announced, HHS issued regulations stating that those individuals, often referred to as DREAMers, would not be eligible for federal healthcare programs. They're prohibited from buying coverage on the state and federal exchanges, even if they pay full price. In essence, their status didn't change at all in terms of eligibility for healthcare programs.
Immigration advocates were surprised and disappointed by the decision. “We all assumed that they would get healthcare and it came down the other way,” said Mara Youdelman, managing attorney with the National Health Law Program. “Many groups have expressed their serious disappointment that the doors to healthcare were closed for DACA eligible individuals.
In some states, most notably California, undocumented immigrants are eligible for coverage paid for by state funds. In addition, pregnant women are eligible for emergency Medicaid to pay for delivering their babies. Otherwise, the country's roughly 11 million undocumented immigrants typically end up at the medical providers of last resort, most notably emergency rooms and community health centers.
The Patient Protection and Affordable Care Act is expected to have little effect on the uninsured rate among undocumented immigrants since they aren't eligible for most benefits. According to a study by researchers at the UCLA Center for Health Policy Research (PDF), more than 60% of nonelderly adults who lack proper immigration documents are expected to remain uninsured under the law.
There's no way to know whether the Obama administration will take the same position for people who are no longer subject to deportation under the president's widely anticipated executive order. There are some signs, however, that the administration's stance on healthcare benefits has shifted.
Last week, HHS Secretary Sylvia Matthews Burwell, speaking to a forum of Latina bloggers, indicated that the administration supports allowing DACA beneficiaries to be eligible for healthcare programs. “This administration feels incredibly strongly about the fact that we need to fix that,” Burwell said. “We need to reform the system and make the changes that we need that will lead to benefits in everything from healthcare to economics.”
Burwell's comments provided hope to immigration advocates that the administration won't follow the same path with the potential new group of immigrants who are not subject to deportation. Priscilla Huang, senior director for impact strategies at the Asian & Pacific Islander American Health Forum, said immigration advocates have communicated that message to administration officials through memos and meetings. “DACA did set a bad precedent, but we think there's still an opportunity not to go down the same road,” Huang said.
Obama's decision to move forward with an overhaul of the nation's immigration policies through executive order is certain to poison relations with congressional Republicans, who are set to control both the House and Senate in 2015. Incoming Senate Majority Leader Mitch McConnell has compared it to “waving a red flag in front of a bull.”
Allowing undocumented immigrants to access healthcare benefits would undoubtedly deepen that standoff. Republicans have long argued that allowing individuals living in the country illegally access to benefits will merely encourage more individuals to cross the border.
Uncertainty is the prevailing sentiment at the moment. Immigration advocates are still waiting to find out exactly when Obama will issue the executive order and how far-reaching the implications will be.
“At this point it's all speculation,” said Steven Lopez, manager of the National Council of La Raza's health policy project. “We are hoping that the president will take action that is both big and bold.”
Follow Paul Demko on Twitter: @MHpdemko
